Cerebrospinal fluid positive for SARS-CoV-2 associated with neurological manifestations and proteome alterations in a multiple myeloma patient.
Jayr Schmidt-Filho, Thais Rodrigues B Geraldo, Victor C Carregari et al.
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Case in brief
A 67-year-old woman with multiple myeloma and recent exposure to a person with COVID-19 developed rapidly progressive dysarthria, dysphagia, and hypoesthesia without respiratory symptoms. She deteriorated to focal and dyscognitive status epilepticus requiring mechanical ventilation. Brain MRI showed features consistent with rhombencephalitis, and SARS-CoV-2 qRT-PCR was positive in both nasopharyngeal and cerebrospinal fluid samples. CSF proteomic analysis showed a neuroinflammatory profile suggestive of blood–brain barrier disruption, with altered expression of proteins including prion protein and SOD-1.
What made this case unusual
SARS-CoV-2 was detected in CSF in a patient with severe neurological disease but no respiratory manifestations; CSF proteomics also identified altered expression of aggregation-prone proteins.
Diagnostic / clinical pearl
In rapidly progressive neurological syndromes with rhombencephalitis features, SARS-CoV-2 may warrant consideration even when respiratory symptoms are absent; this case confirmed infection in CSF by qRT-PCR.
Why it matters
The CSF findings support investigation of SARS-CoV-2 neuroinvasion and its associated proteomic changes, while a single case cannot establish the mechanism.